Shepard Donald S, Lee Samantha R, Halasa-Rappel Yara A, Rincon Perez Carlos Willian, Harker Roa Arturo
Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts, United States of America.
School of Government, University of Los Andes, Bogotá, Colombia.
PLoS One. 2025 Apr 30;20(4):e0307045. doi: 10.1371/journal.pone.0307045. eCollection 2025.
Wolbachia are bacteria that inhibit dengue virus replication within the mosquito. A cluster-randomized trial in Indonesia found Wolbachia reduced virologically-confirmed dengue cases by 77.1%. Previous models predicted Wolbachia to be highly cost-effective in Indonesia, Vietnam, and Brazil. To inform decisions about future extensions in Colombia, we performed economic evaluations of potential Wolbachia deployments in 11 target cities.
We assembled the numbers and distribution by severity of reported dengue cases from Colombia's national disease surveillance system and the health service provision registry (RIPS). An epidemiological panel of three experts estimated the shares of dengue that were non-medical, under-reported, or misreported as another disease. We determined costs (in 2020 US dollars at market prices) of treating dengue illness from the benchmark insurance tariff and RIPS data on treatment services per symptomatic dengue case. Our central estimates projected 10 years of efficacy and focused on Cali, the target city with the highest number of dengue cases.
For Cali, we estimated a net health-sector savings of US$4.95 per person and averting 369 disability-adjusted life years (DALYs) per 100,000 population. From a societal perspective, at 10 years Wolbachia deployment is expected to have highly favorable benefit-cost ratios, with benefits per dollar invested of US$5.50 in Cali and US$4.68 over all target cities.
Over 10 years, Wolbachia is highly beneficial on economic grounds, and almost universally cost saving. The Wolbachia program's economic benefits exceeded its costs in all 11 cities. The program's savings in healthcare costs alone would more than offset deployment costs nationally and in 9 of 11 target cities. Wolbachia is likely to be the most cost-effective or cost-saving dengue control option in municipalities with both high incidence of dengue and high population density, whereas areas with high dengue incidence but low population density should consider vaccination.
沃尔巴克氏体是一种能抑制登革热病毒在蚊子体内复制的细菌。在印度尼西亚进行的一项整群随机试验发现，沃尔巴克氏体可使病毒学确诊的登革热病例减少77.1%。此前的模型预测，在印度尼西亚、越南和巴西，沃尔巴克氏体具有很高的成本效益。为了为哥伦比亚未来扩大应用该方法提供决策依据，我们对11个目标城市潜在的沃尔巴克氏体应用进行了经济评估。
我们汇总了哥伦比亚国家疾病监测系统和卫生服务提供登记处（RIPS）报告的登革热病例数量及按严重程度的分布情况。由三位专家组成的流行病学小组估计了被误诊为其他疾病、未报告或漏报的登革热病例所占比例。我们根据基准保险费率和RIPS中每例有症状登革热病例的治疗服务数据，确定了治疗登革热疾病的成本（以2020年市场价格的美元计算）。我们的主要评估预测了10年的效果，并重点关注登革热病例数最多的目标城市卡利。
对于卡利，我们估计每人可节省4.95美元的卫生部门净支出，每10万人口可避免369个伤残调整生命年（DALY）。从社会角度看，预计在10年的沃尔巴克氏体应用期内，效益成本比非常有利，在卡利每投资1美元的效益为5.50美元，在所有目标城市为4.68美元。
在10年期间，从经济角度看，沃尔巴克氏体非常有益，而且几乎普遍具有成本节约效益。沃尔巴克氏体项目在所有11个城市的经济效益都超过了成本。仅该项目在医疗保健成本方面的节省就将超过全国和11个目标城市中9个城市的应用成本。在登革热发病率高且人口密度大的城市，沃尔巴克氏体可能是最具成本效益或最节省成本的登革热控制选择，而登革热发病率高但人口密度低的地区应考虑接种疫苗。
